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Caldwell B. Esselstyn, Jr., MD

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The Problem with Interventional Drug Therapy for Coronary Heart Disease

Posted: 10/15/10 09:21 AM ET

To fully grasp how so many smart, right-minded people could get it so wrong, it might help to start with a quick review of medical history. Take the radical mastectomy, conceived by William Halsted in the late 19th century. The procedure was intended to remove all cancer cells of the breast, the overlying skin, the underlying muscle and regional lymph nodes. It was mutilating, permanently disfiguring and no more effective than less radical, less disfiguring procedures.

Still, because of the prestige and respect Halsted commanded as a teacher of surgeons, his disciples defended and taught the radical mastectomy at the most revered medical colleges. His extreme procedure was perpetuated for almost a century, until challenges by courageous physicians in Europe and America, along with a prospective randomized study by Dr. Bernard Fisher, finally sounded the death knell of this standardized surgical error of the century.

The 21st-century analogue to this unfortunate chapter is the interventional and pharmaceutical treatment of coronary artery disease. This approach results in significant mortality, morbidity and unsustainable expense. Neither the procedures nor the drugs that accompany them treat the cause. Standard care for coronary artery disease is nothing more than palliative. The purveyors of this treatment acknowledge that it is but a stop-gap therapy. And as in the case of the radical mastectomy, there is a far more effective, cost-effective and sustainable treatment. It's simple: advocate a lifestyle of plant-based nutrition, make a bold leap toward a world free of heart disease and lessen our use of scalpels and drugs.

For the minority of heart patients, specifically those in the midst of heart attacks or acute coronary syndromes, stents or coronary artery bypass may be lifesaving. For the rest, none of the present therapies targets the cause: the Western diet. As a consequence, the disease marches on in all patients, which leads to more drugs, stents and bypasses, increasing heart damage, heart failure and, too often, death.

In 1985, I initiated a study that treated seriously ill patients with coronary artery disease with plant-based nutrition and succeeded in the arrest and reversal of their disease. This program has been published at 5, 12 and 16 years, and most recently summarized at 20 years in my book, "Prevent and Reverse Heart Disease," making it one of the longest investigations of its type in medical research. The duration of the study is testimony that patients with coronary disease will adhere to these food changes for decades and beyond. Patients lose weight, blood pressure normalizes, and Type II diabetes improves or resolves, as do angina, erectile dysfunction and peripheral vascular and carotid disease. Angiographic reversal can be striking. Even more remarkable is the sense of control patients achieve when it comes to containing and reversing their disease.

Our success in counseling patients in how to arrest and reverse heart disease is directly related to the time and effort we expend to help them understand the connection between diet and disease. We succeed where others may fail because of attention to detail. The result: Patients report that this is the most significant and enduring medical encounter they have experienced. More importantly, they acquire an understanding of what caused their disease and how they can stop and reverse it.

Contrary to the argument that "patients won't do this," we find that patients rejoice once they understand their disease and how they may halt it. It is condescending to suggest that patients have no interest in healing themselves. Is the problem that they will not follow advice, or how the advice was offered, if at all? One of my surgical mentors used to say, "Inappropriate application of the method is no excuse for its abandonment."

Present cardiovascular therapy has become a standardized error as it does nothing to prevent disease. In the history of our profession, have we ever before developed an expensive, painful, non-therapeutic treatment of the leading killer of women and men, while failing to inform them of the cause of their illness?

The time is long overdue for legendary work. We can hardly be proud of an interventional and drug therapy, which results in death, morbidity, inordinate expense, disease progression and can never halt this food-borne epidemic. Every patient with this disease should be made aware of this safe, simple, enduring option to cure himself or herself. Most coronary disease need never exist, and where it does exist, it need not progress. Present coronary artery disease therapy need not become the radical mastectomy of this century.

 
 
 
To fully grasp how so many smart, right-minded people could get it so wrong, it might help to start with a quick review of medical history. Take the radical mastectomy, conceived by William Halsted in...
To fully grasp how so many smart, right-minded people could get it so wrong, it might help to start with a quick review of medical history. Take the radical mastectomy, conceived by William Halsted in...
 
 
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09:02 AM on 10/19/2010
Insurance will pay for rehabilitation physical therapy after, say for example, shoulder surgery. So, why is it that after a heart attack or the identification of plaque (atherosclerosis) in the arteries do they not pay for a personal trainer and/or dietician/nutritionist?
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Leslie Robinson Goldberg
Writer
06:15 PM on 10/17/2010
This is kind of a side remark. But some weeks ago when Dr. Dean Ornish wrote a piece with essentially the same message as this piece he was pretty soundly trashed by the HP comments, but Dr. Esselstyn has recieved a pretty good reception. Congratulations doctor! I'm so glad to see this really important message getting out. It takes a lot of guts to speak the truth to the almost unimaginable power of the food industries and their PR armies as well as the medical establishment And let's not forget the know-nothing- but- looks- good media which is nearly always ready to turn itself into a mouthpiece for corporate interests as opposed to serving the public good.
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Chas53
08:38 PM on 10/17/2010
Folks with various agendas like to "shoot the messenger". Dr. Esselstyn is a man of impeccable credentials and character. He, almost single handedly performed a study that convincingly demonstrated that a vegan diet reverses coronary artery disease. Folks take pot-shots with poorly thought out arguments, but science is on his side. I've been on his program for almost a year and I can tell you, it works. BTW I am an MD.
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10:06 PM on 10/17/2010
"He, almost single handedly performed a study that convincingly demonstrated that a vegan diet reverses coronary artery disease."

You sound less like a doctor based in science and more like a preacher. Tell us more how Dr. Essylstyn walked on water to bring us his vegan diet.

Seriously, how do you reconcile the proven cardio-protective benefits of omega-3 fatty acids found in fish with Dr. Essystyn's insistence that they are "bad" because of saturated fat or something like that?
05:10 PM on 10/17/2010
Thank you Dr. E.! Thank you commentators! Thanks to Kindle, I downloaded China Study and read it during the last 24 hours. I found I had already downloaded Dr. E.'s book months ago but I guess I wasn't ready for its message. Also, I have Dr. E's son's book, it's one of my favorites for tasty dishes. Today I cooked a fabulous dinner with spinach potato cakes, spring onions, matchstick tofu,etc. My husband loved it too. I've recently slid ever so slightly into obesity and my blood pressure is creeping up. I want to be a role-model for our grandbabies, and this will be my path.
11:49 PM on 10/18/2010
You should know that the actual China study doesn't support the claims T. Colin Campbell makes in 'The China Study', nor does Rip Esselstyn practice what he preaches.

http://www.proteinpower.com/drmike/cancer/the-china-study-vs-the-china-study/

http://letthemeatmeat.com/post/613456525/vegan-leaders-rip-esselstyn
09:50 AM on 10/17/2010
One problem with this article: It does not go into the damage caused by high-density, processed carbohydrates in our diets.

There are many vegetarians/vegans who are just as unhealthy as meat eaters, because of that. There are also many vegans who do not get complete proteins in their diets.
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Chas53
12:39 PM on 10/17/2010
Good point, this is echoed by Dr. David Ludwig MD PhD. of Harvard. Refined carbs are bad, as they rapidly raise one's blood sugar, leading to a corresponding surge in insulin, which causes rapid fat accumulation and damages one's blood vessels. Much of the obesity in this country is related to the consumption of refined carbs, especially soda pop. Check out www.glycemicindex.com
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Michael Valentine
Retired SEIU Member
01:28 PM on 10/16/2010
I had my heart attack 24 years ago and since then I have had bypass surgery, a defibrillator implanted twice and now take 25 pills a day.

Think I should stop the pills?
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01:55 AM on 10/17/2010
No, not if you want to live. Unfortunately, HP attracts the worst kind of medical advice and unscientific quackery, while the politics is quite good. If there are any randomized clinical trials to prove these claims of Dr. Esselstyn, they should be published quickly, as a lot of lives will be saved. But, alas, there aren't any. All we have are case studies, i.e., individual anecdotes from doctors. Medicine doesn't use the case study approach anymore because it is unreliable. Keep listening to science-based doctors. You would think in countries that follow plant-based diets, they would have no disease or death, but India for example has a life expectancy lower than that of the US and western Europe.
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Chas53
12:34 PM on 10/17/2010
There are; check out the Lyon Heart Study. Dr. Esselstyn has done a great service to medicine/mankind. Through grit and determination, he has proven in peer-reviewed journals that a plant-based diet can reverse heart disease. The current approach of treating coronary artery disease with drugs and technology is merely palliative. Check out Dr. Michael Ozner's website www.drozner.com. and read his book "The Great American Heart Hoax". Stenting stable coronary artery disease does not prevent heart attacks or prolong life. Just as smoking even one cigarette damages one's lungs, in a similar fashion eating one fat laden meal damages one's endothelium (blood vessel lining) leading to atherosclerosis.
Tell me how you would design a "randomized clinical trial" comparing a vegan diet to the standard Western Diet. Read "Overdosed America" by John Abramson MD to see how Pharma has corrupted medical science. There is OVERWHELMING experimental/epidemiological evidence indicating that a plant-based diet prevents coronary artery disease. Dr. Esselstyn has shown with his work that it can also REVERSE heart disease. Also, check out the work of Robt. Vogel MD who has done extensive research on the role of diet in endothelial dysfunction.
Dr. Esselstyn is a man of great accomplishment and integrity. His work stands on it's own merit. As time goes on, his stature will grow.
02:40 AM on 10/30/2010
Wow, I actually looked at Dr. Esselstyn study and found some inconsistencies with his current statements about it... There were 23 patients involved from the beginning, 5 were excluded from the study for non-compliance (here goes his statement that 'patients with coronary disease will adhere to these food changes for decades and beyond'--sure, some will!). The remaining 18 of them, in addition to the diet change, were taking cholesterol-lowering medication (! pills !)...
And, here is a quote from this article: "Combining a plant-based diet with medication achieves better long-term results than changing diet alone or combining modest diet changes and
medication" (http://fnadoc.techtrefoil.com/Health/weil_plus/engine2_diet/esselstyn2.pdf)...
Now, I will use this article for my chronic disease course paper about irresponsible practices of some authors who publish "doctored" materials. By all means, I am all for healthy diet AND lifestyle changes (I am a vegetarian myself), but there is no need to confuse people: many of them need cholesterol-lowering meds in addition to all the holistic staff...
09:45 AM on 10/17/2010
No, not on your own, but you should seek out a doctor whose goal it is to focus on the causes of your heart problems. Assuming they are lifestyle related, work with that doctor and nutritional and fitness professionals to eat the right foods and exercise; then get off the meds, with their guidance.
12:44 PM on 10/16/2010
More and more cancers are being managed by local resection and lymph node sampling - with improved staging and prognosis (See Lund group) - except in gynaecology where surgery is standard.

I was speaking to a cardiologist last week. He had spect four hours in the left atrium "ablating" to treat and arrrhythmia. When he removed the wire, the rhythm returned to normal. When I asked him; "Was he ablating aberrant nerve pathways (See UCLA group) or aberrant myocyte pathways ?" he did not know. Indeed he did not know what I was talking about.

Autonomic denervation and reinnervation occur in every organ from the inferiro turbinate (in acute allergic rhinitis) to the anal cushions (anal fissures). Much is caused by straining during defecation. DP Burkitt was correct to assert that low calorie, plant-based diets with correct patterns of bowel habit, was the correct route to prevention. To assert that it is the correct means to treatment is not a major step.

Autonomic denervation and the origins of Western diseases, 2010 www.western-diseases.com
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April Coleman Rudin
10:17 AM on 10/16/2010
the reason for this is simple: old-fashioned thinking. Medicine, and medical school for that matter, trains doctors to identify symptoms, narrow down with testing and treat with drugs. That is the cycle which needs to be broken...
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JayZee
Biofilm Slayer
09:55 AM on 10/16/2010
A good follow up to this article is this from the Heart Scan Blog..."an analysis of the China Study raw data performed by a young woman named Denise Minger. Denise's analysis is nothing short of brilliant, absolutely "must" reading for anyone interested in nutrition."
http://heartscanblog.blogspot.com/2010/07/china-fiction.html

Also for the heart technology first types.I use this product with the diet and the results are dramatic.
The formula is pricey but you can purchase each ingredient separately and cheap to achieve the same results.http://www.towerlaboratories.com/hearttech.html
12:54 PM on 10/16/2010
Fascinating information. Thanks for pointing it out. I believe this underscores how difficult it is to get honest information about diet and health. I think you just saved me from walking foolishly into a mistake.
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elcerritan
My bio is not micro
05:46 AM on 10/17/2010
Actually, Minger and others have further responded to this "answer" by Campbell, which is less an "answer" to her critique than it is a collection of patronizing put-downs and ad hominem attacks. Since Minger and others made their further responses, Campbell has fallen silent. Not surprising, considering that his book, The China Study, is embarrassing and indefensible pseudo-science.
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StThomas
Not until I see the holes of the nails....
05:42 AM on 10/16/2010
Why, instead of going straight to the public, don't you try to get your colleagues on board, and have them promote it to their patients, after proper evaluation? An effective therapy for ischaemic heart disease which does not involve expensive drugs will certainly catch on with doctors if your numbers can stand up to peer review. Show results, and the NHS in Britain will gladly stop spending money on statins. If your thing works, there is no economic reason for it not to take off there.
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megwolff
Plant-based cook & survivor
09:51 AM on 10/16/2010
There is economic reason, StThomas, surgeries and drugs are very expensive procedures, nutritional advise and follow up pales in comparison.

His colleagues do sent patients to him, but only after they've had all the bypass surgeries and drugs possible nothing more is available. At this point Dr Esselstyn still has a huge success rate in treating them through a plant-based diet.

Great work being done by Dr. Esselstyn. He book is very hopeful. One of the best I've read on the subject.
10:03 AM on 10/16/2010
Thanks.
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StThomas
Not until I see the holes of the nails....
11:25 AM on 10/16/2010
"...still has a huge success rate..."

Yes,but how is that measured?
12:09 PM on 10/18/2010
The sad thing is that some of his colleagues do not send patients to him, but do send their wifes, children and other family members. What does this tell you?
11:54 PM on 10/18/2010
And how do you know this?
02:02 AM on 10/16/2010
Well, I am not trying to live forever (and I don't want to), but I do want to live a life free of paying good money to Big Pharma for their drugs and their dangerous side effects. Geez, do you listen to their commercials. VERY SCARY! I believe that what I have to do is EAT right and exercise, so, I quit smoking, and I am walking, eating more veggies and fruit, and less meat. This is the first time in my life that I have enjoyed my food. Doctors are no good at all until you are dying. That's when their medicines and other treatments are good to have. However, when it comes to preventing dis-ease they are mostly useless. My doctor believes in genetics and that it is futile to try to prevent heart disease. My doctor treats symptoms. Period.
12:09 AM on 10/19/2010
Speaking of Big Pharma, do you realize that people with low cholesterol may have as many strokes and heart attacks as people with high cholesterol. I'm talking about the alleged "bad" cholesterol too. Quite a doctors, biostatisticians and others who have researched this subject consider the cholesterol scare to be a hoax that has been perpetrated for the benefit of Big Pharma.
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01:10 AM on 10/16/2010
This debate seems like it drums up more PR for crooked drug companies. Check out www.mercola.com This dude is right on about everything.
12:21 AM on 10/16/2010
We all have different anscestry, different genes. What might work for some may not work for others. However, hopefully studies like this take into account the diversity among the human population.
10:25 PM on 10/15/2010
Back in 1997 four years after open heart surgery, I started my walking regiment again of 1.5 miles 5 times a week which I hadn't been doing for about a year. Well after about three quartes of a mile I had severe angina which really worried me. I then read Dean Ornish's book about reversing heart disease. I started his vegetarian diet and walking regiment --- kept pushing my walking till I had slight Angina. After 5 weeks on this diet and walking faithfully the angina went away, I lost 10 lbs and could now walk without any angina. Most of all this program gave me hope. I kept this regiment up for 3 years and felt great, then went back to my old bad habits as far as diet and exercise. Well I had another heart attack about 2 years later and had to have a second by pass surgery. Its been 8 years since my second surgery. I still exercise as I should but my diet is not as good (some meat and sweets). I still feel well and attribute this to my medicines Liptor and Niaspan to compensate for my eating habbits. The thing I want to emphasize is that the Dean Ornish program can work for a large majority of people.
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healthcarenow
RN 4 blue Arizona
11:19 PM on 10/15/2010
...and the walking! the heart is a muscle...if you don't use it, you'll lose it, seriously; and walking increases HDL the good cholesterol and lowers LDL, bad cholesterol. Seiously rethink taking cholesterol meds, focus on diet and exercise.
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healthcarenow
RN 4 blue Arizona
11:20 PM on 10/15/2010
oops, forgot... good for you! fanned and faved!
07:35 PM on 10/15/2010
Interesting article. I have an uncommon problem in that I have a hard time keeping weight on. I also get orthostatic hypotension regularly and dehydrate easily. I have extremely poor appetite, and often go without eating for a day a few times a week. Eating makes me very uncomfortable. I especially dislike the taste of most meat, cheese, very sweet, or fried foods. I do enjoy fresh fruits and vegetables, but many vegetables cause painful digestion. I'd like to try an all plant-based diet, but I am concerned I would waste away further. When my weight drops too low, below 90, I force myself to eat high fat foods to get it back on...very unpleasant. Anyone out there have experience with this type of problem and is a plant-based diet possible?
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margoharris
I used to be Snow White but I drifted.
10:27 PM on 10/15/2010
Smoke some quality cannabis. Then plan your meals around a balanced diet, that includes protein from beans, legumes, lentils. Make soup with leafy green vegtables. I like a spicy italian turkey sausage soup with potatoes onions kale celery kidney beans and kale with canned diced tomates. Add the kale last.
And drink a milkshake now and then.
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healthcarenow
RN 4 blue Arizona
11:24 PM on 10/15/2010
very good!
01:02 PM on 10/16/2010
Thank you for your kind response. Unfortunately, cannabis is illegal where I am.
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healthcarenow
RN 4 blue Arizona
11:23 PM on 10/15/2010
you need protein asap! beans, lentils, dairy products; also add good carbs...high fiber bread, pasta. Good luck!
01:06 PM on 10/16/2010
Thank you for your response. I believe I have a high protein diet already. I eat a lot of eggs from our chickens, and chicken from our chickens. I appreciate the response. It seems very difficult to untangle dietary issues. This may be part of the problem in resolving how people approach the issue.
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edgarcaycedoc
06:55 PM on 10/15/2010
My father was told in 1953 that he could only live, AT THE MOST, five years without a radical new surgery (coronary bypass). We couldn't afford the procedure, and my father declined to have it. He died in 1981. THAT was a long five years!!
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bthechangeyouseek
08:29 PM on 10/15/2010
I think doctors mean well for the most part. But many studies published and several books discuss how many procedures are done for profit motive.
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healthcarenow
RN 4 blue Arizona
11:29 PM on 10/15/2010
not so much profit as protection against liability of not offering; people demand things that are inapprpriate and in some cases dangerous; medicine is defensive now...and people don't want to work at anything, just the "fast fix". Eat your veggies, beans and fiber, and take the stairs everytime!
09:17 PM on 10/15/2010
And I know someone on the verge of death who had open heart surgery and is still alive many years later. So there are anecdotes and there are anecdotes, but science is based on carefully controlled samples.